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Cost-effectiveness of supported employment for veterans with spinal cord injuries.

Sinnott PL, Joyce V, Su P, Ottomanelli L, Goetz LL, Wagner TH. Cost-effectiveness of supported employment for veterans with spinal cord injuries. Archives of physical medicine and rehabilitation. 2014 Jul 1; 95(7):1254-61.

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OBJECTIVE: To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs). DESIGN: Cost-effectiveness analysis, using cost and quality-of-life data gathered in a trial of SE for veterans with SCI. SETTING: SCI centers in the Veterans Health Administration. PARTICIPANTS: Subjects (N = 157) who completed a study of SE in 6 SCI centers. Subjects were randomly assigned to the intervention of SE (n = 81) or treatment as usual (n = 76). INTERVENTION: A vocational rehabilitation program of SE for veterans with SCI. MAIN OUTCOME MEASURES: Costs and quality-adjusted life years, which were estimated from the Veterans Rand 36-Item Health Survey, extrapolated to Veterans Rand 6 Dimension utilities. RESULTS: Average cost for the SE intervention was $1821. In 1 year of follow-up, estimated total costs, including health care utilization and travel expenses, and average quality-adjusted life years were not significantly different between groups, suggesting the Spinal Cord Injury Vocational Integration Program intervention was not cost-effective compared with usual care. CONCLUSIONS: An intensive program of SE for veterans with SCI, which is more effective in achieving competitive employment, is not cost-effective after 1 year of follow-up. Longer follow-up and a larger study sample will be necessary to determine whether SE yields benefits and is cost-effective in the long run for a population with SCI.

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